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Sugar or substitute?

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Sugar contributes to tooth decay and obesity, but still we spoon it onto cereal and into coffee (and the food industry puts heapsknown as added sugarinto products).

"Americans eat 165 pounds of added sugar each year, and sugar substitutes are on the rise as well, which are hundreds of times sweeter than table sugar," says Frances Largeman-Roth, RD, author of Feed the Belly and co-author of The Carb Lovers Diet.

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Sucrose

The deal: Sucrose offers energy but no nutritional benefits. In 2003, a team of international experts recommended that added sugars make up no more than 10% of your diet, or about 12 teaspoons (50 grams) for a 2,000-calorie diet.

But in 2009 the American Heart Association slashed that even further suggested women consume no more than 6 teaspoons (25 grams) of added sugar and men no more than 9 (37.5 grams).

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Acesulfame potassium

The deal: This nonnutritive artificial sweetener was first approved by the Food and Drug Administration (FDA) in 1988, meaning it now has a 22-year track record in which no problems have surfaced.

However, pre-market testing was sparse. Hoescht, the manufacturer of the chemical, ran a few long-term animal studies that showed it might be linked to cancer (although animal studies don’t always translate to humans).

In 1996, the Center for Science in the Public Interest (CSPI) urged the FDA to require better testing, but for now it seems to be safe in moderation.

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Agave nectar

Calories: 20 per teaspoon Found in: Cereals, yogurts, tea

The deal: The nectar is a product of the agave cactus, and its taste and texture are similar to honey.

It doesn’t contain as many antioxidants as honey, but it contains approximately the same amount of calories. Agave, however, is sweeter than sugar, so proponents suggest you can use less to get similar sweetness.

It contains more fructose than table sugar, which, according to a recent study, means it is less likely to cause a spike in blood sugar but could be more likely to reduce your metabolism and insulin sensitivity.

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Aspartame

The deal: One of the most studied artificial sweeteners, aspartame has been accused of causing everything from weight gain to cancer.

However, since being approved by the FDA in 1981, studies have found no convincing evidence and the FDA, the World Health Organization, and the American Dietetic Association say aspartame in moderation poses no threats.

The CSPI feels differently, and gave it their lowest ranking in a review of food additives. People with phenylketonuria, an inherited genetic disorder, should avoid it.

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Stevia leaf extract

The deal: Derived from the stevia plant, stevia leaf extract, also called rebiana, is deemed the natural alternative to artificial sweeteners.

Although crude stevia extracts are not approved by the FDA, refined stevia products such as Truvia gained a Generally Regarded As Safe (GRAS) approval from the FDA in 2008.

In 2013, the consumer advocacy group Center for Science in the Public Interest said it "considers rebiana, a natural high-potency sweetener obtained from stevia, to be "safe," though deserving of better testing."

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Saccharin

The deal: Rat studies in the early 1970s found a link between consuming Saccharin and bladder cancer, prompting Congress to mandate in 1981 that all foods containing it bear a warning label.

Later studies showed that these results may only occur in rats, and there was a lack of evidence that saccharin causes cancer in humans. Saccharin was removed from the U.S. National Toxicology Program’s Report on Carcinogens in 2000 and Congress repealed the warning label.

The CSPI places it on their "avoid" list, acknowledging that Congress’s removal of the label will likely result in greater use of the sweetener.

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Sucralose

The deal: Sucralose received FDA approval in 1998, and although one study showed it may negatively impact the immune system, follow-up studies did not find a correlation.

The CSPI deems it safe, and several studies have found that it is not carcinogenic. This sweetener is one of the few not sensitive to heat and can therefore be used in baking, useful for those limiting empty-calorie carbohydrates because they are dieting or have diabetes.

Although they’re generally less sweet and caloric than sugar, eating large amounts (particularly of mannitol) can cause bloating and diarrhea. They’re often used in sugar-free foods marketed to diabetics, because they contain fewer carbohydrates than table sugar. They do contain some carbohydrates, so eating them in excess may increase blood sugar.

The ADA recommends consuming sugar alcohols in moderation, and counting half of the grams of sugar alcohols as carbohydrates because only about half get digested.